Ethical Challenges in the Practice of Echocardiography: What Is Right and How Do We Do It?

At the 2018 Scientific Sessions, the American Society of Echocardiography inaugurated the Richard E. Kerber Ethics/Humanitarian Lecture, continuing its tradition of providing ethics education and exploring the use of echocardiography to improve cardiovascular care in medically underserved settings. Echocardiography is one of the most widely applicable, safe, and cost-effective diagnostic tools available in cardiovascular medicine. The American Society of Echocardiography Foundation is well known for harnessing the power of echocardiography in its many successful humanitarian outreaches all over the world. Some practitioners might conclude that because of its important advantages, echocardiography involves few ethical complexities; however, several historical and recent scandals involving conflicts of interest and lapses in quality suggest otherwise. Every day, sonographers and echocardiographers grapple with ethical issues: integrity, truth telling, doing good and avoiding harm, altruism, and humanism. In the near future, population aging and technological advances, among other issues, will ensure that a steady stream of ethical issues will confront the practitioners of echocardiography. Medical science and engineering have given us many things that can be done, but central to the art of medical practice and research are decisions about what should be done. In this article, based in part on the first Richard E. Kerber Ethics/Humanitarian Lecture, the authors discuss ethical challenges in the practice of echocardiography, illustrated by accompanying online videos, and offer a general principle for meeting these challenges.

Cribado prenatal de cardiopatías congénitas en población de bajo riesgo de defectos congénitos. Una realidad en la actualidad / Prenatal screening of congenital heart defects in population at low risk of congenital defects. A reality today

INTRODUCCIÓN: Nos proponemos demostrar que es posible la implantación de un cribado prenatal de cardiopatías congénitas de garantía (sensibilidad diagnóstica para malformaciones cardíacas mayores del 90%) y universal (aplicado a más del 90% de las gestantes). MATERIAL Y MÉTODO: Estudio prospectivo. Hemos valorado a 12.478 gestantes (enero del 2008-diciembre del 2010). Realizamos un cribado de cardiopatías congénitas aplicando una ecocardiografía fetal básica ampliada. RESULTADOS: La prevalencia de los defectos congénitos en general y de las cardiopatías congénitas es del 2,5% (2,2-2,7%) y el 0,9% (0,7-1%), respectivamente. Las cardiopatías congénitas presentan una tasa de asociación a otras malformaciones estructurales del 11,5% (5,6-17,4%), 21% en caso de cardiopatía congénita mayor (9,9-32%) y a cromosomopatías del 15,9% (9,1- 22,7%), 32,6% en caso de cardiopatía congénita mayor (19,8-45,3%). Hemos logrado realizar una valoración ecográfica cardiaca fetal al 99,2% de las gestantes. La ecocardiografía fetal presenta, para el diagnóstico de las cardiopatías congénitas en general y de las cardiopatías congénitas mayores, una sensibilidad 42,8% (33,5-52,5%) y el 90,4% (78,9-96,8%), respectivamente, y una especificidad para ambas del 99,9% (99,8-99,9%). CONCLUSIONES: Es posible realizar un cribado prenatal de garantías y universal de las cardiopatías congénitas mayores

INTRODUCTION: We propose to demonstrate that it is possible to implement a valid (diagnostic sensitivity for major cardiac malformations 90%), and universal (applied to over 90% of pregnant women), prenatal screening method for congenital heart defects. MATERIALS AND METHODS: Prospective study. A total of 12478 pregnant women were evaluated between January 2008 and December 2010. Congenital heart diseases were screened using fetal extended basic echocardiography (cardiac ultrasound). RESULTS: The prevalence of birth defects in general and congenital heart disease was 2.5% (2.2- 2.7%) and 0.9% (0.7-1%) respectively. Congenital heart disease had a higher rate of association with other structural abnormalities with 11.5% (5.6-17.4%), 21% for major congenital heart disease (9.9-32%), and chromosomal abnormalities of 15.9% (9.1-22.7%), with 32.6% for major congenital heart disease (19.8-45.3%). A fetal cardiac ultrasound assessment was performed on 99.2% of pregnant women. The fetal echocardiography is useful for the diagnosis of congenital heart disease in general, and major congenital heart disease, with a sensitivity of 42.8% (33.5- 52.5%) and 90.4% (78.9-96.8%), respectively, and a specificity for both of 99.9% (99.8-99.9%). CONCLUSIONS: It is possible to perform a valid prenatal and universal screening of major congenital heart disease

Guía de práctica clínica sobre el tratamiento de las valvulopatías (versión 2012) / Guidelines on the Management of Valvular Heart disease (Version 2012)

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